¿Por qué los portales subcutáneos se quedan atorados? Un estudio de casos y controles | Portales colocados entre2014-2017 removidos para 2019 | 1 sola institución | Estudio prospectivo de casos y controles | 57 portales atascados & 171 controles fueron analizados | Los catéteres atascados se relacionaron con: | Diagnóstico de Leucemia Linfoblástica aguda (ALL) (p<0.001) | Largo tiempo de colocado (p<0.001) | Catéteres de poliuretano (p<0.0001) | Catéteres Subclavios (p=0.0126) | Conclusiones: | Los catéteres de poliuretano colocados en pacientes con ALL hace más de 2 años, pueden ser difíciles de retirar. | Una discusión preoperatoria más extensa, disponibilidad de hemodinamia y una programación de mayor tiempo quirúrgico debe ser garantizado. | https://doi.org/10.1016/j.jpedsurg.2021.08.003 | @StayCurrentMD | Source: Crook et al. | Departamento de Cirugía, Hospital de niños St. Jude, Memphis, TN, Estados Unidos | Alex Halpern, MD @EmTombash | Cincinnati Children's | Journal of Pediatric Surgery
¿Por qué los portales subcutáneos se quedan atorados?
Infographic · Dec 2022 · 1 min read
In brief
In brief
This case-control study identifies risk factors for difficult subcutaneous port removals in children, finding strong associations with acute lymphoblastic leukemia diagnosis, longer placement duration, subclavian access, and polyurethane catheters. The research provides evidence to guide port selection and anticipate removal challenges in pediatric oncology patients.
- Polyurethane catheters placed for ALL treatment have significantly higher risk of becoming stuck during removal after 2+ years.
- 86% of stuck ports occurred in ALL patients vs 22% in controls; median placement duration was 2.6 years vs 0.8 years.
- Subclavian access and polyurethane material (vs silicone) were associated with difficult removals requiring longer OR time.
- 10 cases required endovascular intervention; preoperative counseling should address stuck port risk in long-term ALL patients.
- Rough catheter appearance at removal was present in 93% of stuck ports vs only 9% of controls.
Written by the GCMD Library team from the infographic.
A teal and gray infographic divided into sections with calendar and medical icons at top, cartoon illustrations of a child and healthcare worker in middle, and patient-nurse scene at bottom. Statistical findings are presented with bullet points and emphasis boxes. Color scheme uses teal, orange, and white with simple line-art illustrations throughout.
Nueva infografía por Alex Halpern y Em Tombash
"¿Por qué los cateteres implantables quedan atascados? Un estudio de casos y controles" Jennifer Crook et.al.
Articulo completo: https://www.jpedsurg.org/article/S0022-3468(21)00537-6/fulltext
Autores: Jennifer L. Crook, Zhaohua Lu, Xiaoqing Wang, Nan Henderson, Kimberly E. Proctor, Vinod G. Maller, Hasmukh J. Prajapati, Robert E. Gold, Abdelhafeez H. Abdelhafeez, Lindsay J. Talbot, Ching-Hon Pui, Andrew M. Davidoff, James M. Hoffman, Andrew J. Murphy
Abstract
Purpose
We sought to identify clinical features associated with difficult subcutaneous port removals in children.
Methods
Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations.
Results
57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5–2.6] versus 0.8 years [IQR 0.5–1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis.
Conclusion
Polyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.